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Published on: March 24, 2023
Costs and performance of early hearing detection programmes in Lagos, Nigeria
B O Olusanya1, A Emokpae, J K Renner
1Institute of Child Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria. boolusanya@aol.com
Insights
Community-based universal infant hearing screening is the most cost-effective method for early detection of permanent congenital and early-onset hearing loss (PCEHL) in low-income countries, offering higher detection yields and lower costs.
Area of Science:
- Public Health
- Audiology
- Health Economics
Background:
- Early detection of permanent congenital and early-onset hearing loss (PCEHL) is crucial for child development.
- Evaluating cost-effectiveness of different infant hearing screening models is essential for resource-limited settings.
Purpose of the Study:
- To compare the costs and performance of hospital-based versus community-based infant hearing screening models in Lagos, Nigeria.
- To determine the most cost-effective strategy for PCEHL detection in a low-income country context.
Main Methods:
- A two-stage screening protocol using transient-evoked otoacoustic emissions and automated auditory brainstem response.
- Evaluation of referral rates, cost per baby screened, cost per case detected, and yield for PCEHL.
- Comparison between universal and targeted screening approaches in both hospital and community settings.
Main Results:
- Community-based universal screening yielded the highest detection rates (27.4 per 1000).
- Community-based universal screening was the most cost-effective, with the lowest cost per child screened (US$7.62) and lowest cost per PCEHL case detected (US$602.49).
- Hospital-based targeted screening was the least cost-effective model.
Conclusions:
- Community-based universal infant hearing screening, integrated with routine immunisation clinics, is the most cost-effective model for early detection of PCEHL in low-income countries.
- This model offers a pragmatic and efficient approach to addressing hearing loss in infants in resource-constrained environments.
Abstract:
In line with global progress towards early detection of permanent congenital and early-onset hearing loss (PCEHL), the costs and performance of hospital-based and community-based infant hearing screening models were evaluated in Lagos, Nigeria. The protocol consisted of two-stage screening with transient-evoked otoacoustic emissions and automated auditory brainstem response followed by diagnostic evaluation for all infants referred after the second-stage screening. The main outcome measures were referral rates at screening, cost per baby screened, cost per case detected and yield for PCEHL. First-stage referrals were 32.2% for universal and 31.7% for targeted screening in the hospital, compared with 14.3% and 15.2%, respectively for the community-based programme. Second-stage referrals ranged from 3.3% under hospital-based universal screening to 4.9% under community-based targeted screening. The highest yields of 27.4 and 22.5 per 1000 were recorded under community-based targeted and universal screening, respectively. Screening cost per child was lowest (US$7.62) under community-based universal screening and highest (US$73.24) under hospital-based targeted screening. Similarly, cost per child detected with PCEHL was lowest (US$602.49) for community-based universal screening and highest (US$4631.33) for hospital-based targeted screening. Community-based universal screening of infants during routine immunisation clinics appears to be the most cost-effective model for early detection of PCEHL in low-income countries.
